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02/08/2012 6�TSD 15:18 FAX 402 471 4429 UCC SECRETARY OF STATE �-+� 9a11 <br />� <br />b �ortn 668 (Y)(c) <br />�Rev. February 2004) <br />xe se� <br />5 9.2 <br />Department of the Treasury - Internal Revenue Ser�•" <br />I�lotir,� of Federa[ '�ax L'e�n <br />Area: Serial Number <br />SMALL'BIISINFSS/SELF EMPI,OYED AREA #4 <br />Lien Unit Phone: •(800) 913-6050 846190012 <br />As provided by sectioe 6321, b322, and 6323 of the Internai Revenue <br />Code, we are �gmring a notice that taxa (including interest and penalties) <br />have been auessed against the following-named taxpayer. We have rnade <br />a demand for payment o� this liability, but it remairrs un�aid. 'Therefcre� <br />there is a lien in favor of the United States un all property and rigl�ts to <br />property belonging to this taxpayer for the amount of these taxes, and i <br />additional penalties, interest, •and costs that may auruc. , <br />ame <br />20120�028 <br />�ooa/ooa <br />- ua �r� <br />Pes: 1 <br />L <br />55 PM <br />�. <br />r <br />Residence I816 PARK AVE <br />GR.AND ISLAND, NE 68803-2730 <br />IMPORTANT RELEASE (NEORMATiON For each assessment tisted 6elow, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the � day following such date, operate as a certificate of release as defined <br />in lRC 63251a). <br />Tax Period D�se of Last Da fmr <br />Kind of T� Ending Identi[ying Idumber Assessmee�t t��8 <br />1040 12/31/2008 <br />1040 12/31j2409 <br />1040 12/31/2009 <br />Place of Filing <br />unpa�d Balance <br />of Assesseaent <br />XXX-XX-9131 06/07/2010 07/07/2020 <br />XXX-XX-9131 05/10/2010 06/09/2020 <br />XXX-XX-9131 11/28/2011 12/28f2021 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total � $ <br />This notice was preRared and signed at CHICAGO, IL <br />the 3 �� h day ofi January 2012 <br />, <br />, on this, j:� <br />,. <br />Signature Title � <br />�t` REVENUE OFFICER 24-10-1721 <br />for ERIC MARTIN (402) 473-4674 <br />(NO'iE: Certificate of officer authorized by law to take acknowledgment is not essential to tne validity of hotice of Federal Tax lien �� : <br />Rev. Rul. 71-466, 1971 - 2 C.6. 4Q91 Form 668(Y)(c) (Rev. 2-2004) �. <br />Part 1- Kept By Recording Cftice CAT. NO 60025X �. �• <br />1476.06 <br />7.193 . 38 <br />2669.44 <br />